When Sutures Fail: Extrusion of an Inspire Device and a Hip Prosthesis in the Same Patient

Implant extrusion is a rare but serious complication typically linked to infection, poor wound healing, or material intolerance. This case report describes a 79-year-old female patient who experienced extrusion of both a hip prosthesis and an Inspire hypoglossal nerve stimulator (Inspire Medical Systems, Inc., Minnesota, USA), each event associated with the use of Ethibond (Ethicon, Johnson & Johnson, Georgia, USA) sutures. The patient had a history of obstructive sleep apnea refractory to continuous positive airway pressure (CPAP) therapy and underwent Inspire device implantation. Postoperatively, she developed a sterile fluid collection and wound dehiscence, leading to visible extrusion of the device. Notably, she had previously experienced a near extrusion of a hip prosthesis, also linked to Ethibond. In both cases, the infectious workup was negative. Following explantation and reimplantation of the Inspire device using Monocryl and Prolene sutures (both by Ethicon, Johnson & Johnson, Georgia, USA) and the application of a dermal graft, the patient achieved successful healing without recurrence. This case underscores the importance of considering suture-related foreign body reactions in patients with recurrent implant extrusion and no evidence of infection. Surgeons should remain vigilant in selecting suture materials, especially in patients with a history of adverse reactions, and future research should explore suture-tissue interactions to guide safer implant practices.